What Are Shingles?
Shingles, also known as herpes zoster, is a disorder caused by varicella zoster, the same virus that causes chicken pox. After an attack of chicken pox, usually a childhood disease, the virus does not die but rather lies dormant in the nerve cells that extend from the spinal cord or the brain out into the body. Years later, the virus may be reactivated and migrate along the path of a nerve to the surface of the skin, where it causes a rash of painful blisters.
While it is generally not a dangerous condition, shingles can be extremely painful. But in most people, the lesions heal and pain diminishes within three to five weeks. The prognosis is generally good, unless the virus spreads to the brain or spinal cord or to the eyes. Some shingles sufferers, however, experience lingering nerve pain (postherpetic neuralgia) that can persist for months or even years after the rash is gone. The pain is not from shingles, but from nerve cell damage caused by viral infection.
Who Gets Shingles?
Shingles strikes about one in five adults who have had chicken pox as children. While shingles can occur at any age, more than two-thirds of cases occur in people over 50 years of age. Usually an attack of shingles only occurs once, but it is possible to have a recurrent outbreak.
Shingles is 20 to 100 times more common in immune compromised individuals, such as HIV patients and the elderly, as well as those whose immune systems are suppressed by medication or chemotherapy (for example, cancer patients).
- In early stages, a sensation of tingling followed by pain (often accompanied by fever and headache), preceding the development of the rash by several days.
- Severe pain and itching in a bandlike rash of small, red, fluid-filled blisters on one side of the torso, arms, legs, or face lasting from about one to four weeks. About 10 days after their appearance, blisters dry up into scabs.
- Persistent, severe pain after the rash has subsided, called postherpetic neuralgia, occurs in 10% to 15% of cases and is common in the elderly. Other serious complications of herpes zoster infection include possible pneumonia, deafness, or meningoencephalitis (infection of the brain and surrounding tissues).
- Shingles is caused by reactivation of the dormant varicella zoster virus. You cannot “catch” shingles from someone who has shingles.
- The virus can be transmitted to others, but only to someone who has never had chicken pox, and only if that person is exposed directly to the rash—in which case the person might develop chicken pox, not shingles.
- How or why the herpes zoster virus is reactivated is uncertain. It is believed that the virus reactivates when the immune system—owing to age, illness, stress, or the use of immunosuppressant drugs—becomes too weak to keep the virus in a state of dormancy. Immunosuppressed patients are at increased risk for shingles.
What If You Do Nothing?
In most cases shingles is self-limiting—the body’s immune system is ordinarily able to fight off the infection. However, the pain can be severe, and many people need medication for pain relief. Early treatment with antiviral drugs can also be important in bringing relief.
Medical intervention is critical, however, for people with damaged or suppressed immune systems. Not only are they vulnerable to shingles, but if they develop symptoms, there is a danger that the disease will spread and reach vital organs like the lungs, with results that are fatal.
- Shingles is suspected based on typical skin lesions and a history of chicken pox or shingles.
- A direct microscopic examination or culture of the skin lesions may be taken to confirm the diagnosis.
Treatment for shingles is aimed at relieving discomfort and pain while the disorder runs its course.
- Apply cool, wet compresses or ice packs to reduce pain.
- For minor discomfort, take over-the-counter NSAIDs (aspirin, ibuprofen, or naproxen) or acetaminophen.
- Calamine lotion and oatmeal or cornstarch baths can help relieve itching.
- Avoid scratching in order to minimize the risk of infecting blisters with dirt from fingernails.
- Use soap and water to keep the rash area clean.
- Capsaicin cream, an extract made of hot peppers, sold over-the-counter, has been used in pain clinics to reduce postherpetic neuralgia pain by interrupting the transmission of pain impulses to the brain. Consult your physician before using it. Be sure not to apply it until the lesions caused by your shingles have completely healed.
- During the early stages, antiviral drugs, such as acyclovir, may be combined with a potent corticosteroid drug (such as prednisone), which speeds healing and lessens the duration of severe pain.
- Medications that impede nerve impulses, such as carbamazepine, gabapentin, and amitriptyline, may be used for more serious cases of postherpetic neuralgia.
- Narcotics may be prescribed to control severe pain.
- In the most severe or persistent cases, injections of blocking agents directly into nerves may be used to prevent pain signals from reaching the brain.
- There is no known way to prevent shingles. However, to be on the safe side, if you’ve never had chicken pox, it’s best to avoid contact with the active rash of anyone with shingles or chicken pox.
- The herpes zoster vaccine (Zostavax) is recommended by the Centers for Disease Control and Prevention (CDC) for healthy adults ages 60 and older. The vaccine may prevent shingles (or a recurrence of shingles if you've already had an attack). People with weakened immune systems cannot receive the herpes zoster virus because it contains live, although weakened, virus.
When To Call Your Doctor
- Call a doctor if you develop symptoms of shingles. The earlier the symptoms are treated, the less severe the ailment may be.
- See a doctor or ophthalmologist immediately if shingles occurs around the eye or affects vision. Eye damage from shingles can lead to blindness.
Robert Hurd, M.D., American Board of Internal Medicine and Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network.